Sports Neurology Expert Witnesses and Concussions

Concussions have been front and center in the news for the last few years. According to the Mayo Clinic, a concussion is “a traumatic brain injury that alters the way the brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. ” Technological advances in Sports Neurology have doctors concerned that such a broad definition does the public a great and very harmful disservice.

photo courtesy of premierelife.ca

Photo Courtesy of Premierelife.ca

In his article, “Plain Talk On Concussions,” Sports Neurologist, Dr. Vernon Williams, explains that the public’s understanding of concussions has been oversimplified for many years.  There are many factors to take into consideration when evaluating a patient. They can include previous brain injury, age, and even gender. Dr. Williams explains that,

“You can’t see a concussion on x-ray, CAT scan, or most MRI’s. But the lack of abnormality on those tests does not mean the brain hasn’t been injured. The injury occurs on a cellular level. When special methods are used, there is evidence of change in how the brain is working that last for days to weeks (evidence of persistent brain dysfunction) even when the injured athlete feels that they are back to 100% and the physical examination is normal.”

Players who engage in high contact sports like football  have a high risk for concussion. The problem has become so pervasive that parents and players have pressured the  NFL and the NCAA to tighten safety standards.  Innovations in helmet safety have come too late for many players. When NFL Hall of Famer, Mike Webster, was diagnosed with a progressive degenerative disease of the brain known as CTE, fellow retirees took note. Before his death, Webster suffered from amnesia, dementia, depression, and chronic pain, all symptoms of CTE.

Since then, approximately 5,000 retired players have filed suit against the NFL alleging the entity hid the dangers of concussions. Among the plaintiffs in these lawsuits are Art Monk, Tony Dorsett, Jim McMahon, Jamal Anderson, and Ray Easterling. Considering how high profile these cases have become, it is no wonder that brain injury has become a growing concern in Sports Medicine litigation.

Concussion litigation in the NFL, sports clubs, and even in school yards across the country have garnered so much attention that George Washington University’s law school has developed a course devoted solely to the legal implications of traumatic brain injuries.  Michael Kaplen, who teaches the course, is a plaintiffs’ lawyer who has worked on cases involving traumatic brain injuries for more than two decades. Kaplen believes the NFL became responsible for the safety of its players when it began studying the cause and effect of concussions over twenty years ago. (See article in The NewYorkTimes.com).

Public safety is the common thread for sports neurologists like Dr. Vernon Williams and litigators like Michael Kaplen.  With advances in medical technology, doctors have learned that the basic warning signs of a concussion which have prevailed for so many years are no longer sufficient. In light of this progress, making the NFL and other organizations accountable for the well-being of its players may be the catalyst to improved neurological health not only for athletes, but for everyone who has suffered traumatic brain injury.

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*Vernon B. Williams, MD specializes in Sports Concussions, Sports Neurology, and Pain Medicine. Dr. Williams is the Founding Director, Center for Sports Neurology and Pain Medicine at the Kerlan-Jobe Orthopedic Clinic in Los Angeles, CA. His clients include the Los Angeles Lakers, Los Angeles Dodgers, Los Angeles Kings, Los Angeles Sparks, among many others.  Dr. Williams’ Profiles on Experts.com.

 

 

 

 

Should A Medical Society Discipline A Medical Expert Witness For Submitting A “Draft Report?”

Attorneys often retain expert witnesses to consult on a case, to testify at trial or deposition, or to provide a formal written opinion to the court.  Like any other professional engagement, the process usually involves several communications, back and forth, between the attorney and the expert witness, often including preliminary written or oral opinions.

Imagine if you were retained as a medical expert witness,  had written a rough draft, preliminary opinion, and submitted it, mistakes and all, for initial consideration. Then, imagine if this document had been used in court without your knowledge, and the next thing you know, you’re being disciplined based on the quality of the document. 

Something like this actually took place, and the results may have lasting results for those in the medical community. In May, a California jury determined that the American Academy of Orthopedic Surgeons (AAOS) was liable for falsely portraying an orthopedic surgeon after he had acted as an expert witness in a medical negligence case. It seems that the AAOS had suspended the medical expert for allegedly providing improper testimony in the case. Normally, the AAOS would have every legal right to discipline the doctor, but here’s the catch: According to the doctor, the “expert testimony” used in the negligence case was the preliminary report  he had submitted to the plaintiff’s attorney who retained him. It was, therefore, not meant to be used in court. Even worse, according to the doctor, the plaintiff’s attorney had removed the words “draft report” without the doctor’s knowledge. This, in itself, is questionable behavior.  For the AAOS to then suspend the Medical Expert and falsely portray him in its publication is certainly overstepping. This, at least, was the finding of the jury, though of course the AAOS is doing all it can to fight this verdict. It is worth mentioning that the jury verdict awarded damages to the doctor against the law firm as well.

 This is a unique case that could have profound implications, not just for the AAOS but for the medical industry as a whole. If a precedent has been set that expert witnesses can successfully sue medical societies, then this is certain to send shock waves throughout the medical community. Expert witnesses should be permitted to submit preliminary drafts before finalizing the report that will actually be used in court. More importantly, no one—attorney or otherwise—should have the right to alter a draft report and misrepresent it as expert testimony. Furthermore, this case, which is among the first instances of an expert witness successfully challenging a medical society’s disciplinary action in court, may compel these societies to think twice before committing what is essentially libel.

As we might expect, this story is far from over – we could say that it’s still in the “draft report” phase. Judging from what happened to one medical expert, it’s probably wise to keep that draft report in safe keeping….

PHARMACEUTICAL PRODUCT LIABILITY

With the onslaught of legal drugs on the market, pharmaceutical product liability cases have become mainstream in the court system.  It boggles the mind how many possible harmful side effects there are for one medication alone.  Just listen to any commercial for depression medicine – and you’d better listen carefully.  They have to speak quickly to get them all in.

If a pharmaceutical company lists all possible harmful effects, does that relieve them from liability?  Do a certain number of people have to die or have a stroke in order for the drug to be pulled from the market?  Conversely, did the patient do something to exacerbate the problem?  Take too much of the medicine?  Not enough?  Is the pharmacy liable for miscalculating the dosage?

This is when Pharmaceutical, Pharmacology and Toxicology Experts and Consultants come into play.  The variables are so complex and many that a case cannot be thoroughly adjudicated without the scientific and practical experience that these particular Experts hold.  They use their skills to review medical and pharmacy records, evaluate drug delivery standards of care, toxicity, adverse drug events and even FDA regulations.  These Experts and Consultants are retained to determine the period of time a drug was used and a patient’s average compliance or adherence to taking a drug, among so many other things.

The bottom line is that Pharmaceutical, Pharmacology and Toxicology Experts and Consultants are essential to resolving complex medical issues involving pharmaceuticals and drugs.  That they play a major role in helping to regulate the industry, compensate the injured and defend the innocent cannot be denied.

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